Provider Demographics
NPI:1386341964
Name:DE CASTRO, ISABELLE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19381 STONEBROOK ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2430
Mailing Address - Country:US
Mailing Address - Phone:954-294-8414
Mailing Address - Fax:
Practice Address - Street 1:19381 STONEBROOK ST
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33332-2430
Practice Address - Country:US
Practice Address - Phone:954-294-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist